Blood Sugar Trampoline

Social Media & Information Blindness

I’m beginning to feel like I am becoming blind to information if it’s not being blasted at me on social media. If it’s not a flashy click bait image. And I think it’s making my brain die slowly.

Photo credit Pixaby.com

Last week, my husband told me, (and I heard him tell me!!!, not the nod and yes response), that our broccoli in the garden was ready for picking and we shouldn’t buy any for a number of weeks. Shortly after being told this, like an hour, I was doing the shopping and saw that broccoli was half price. What a bargain, I thought and bought it. What happened to my brain? Where did that piece of information go??

Is it that I’m so used to having instant information and that information is so easy to retrieve at any time on any device that my brain has forgotten how to retain information?

Ireland in the 80’s it was so easy to inform people and be informed. We only had two tv channels (rural Ireland that is – No Sky channel for us), two national radio stations and maybe one weekly local newspaper, we did have a couple of daily national broadsheets too. this meant was it was extremely difficult to be unaware of anything newsworthy and if you needed to get a public information message to the people the telly and radio were both sure things.

These days though it’s extremely difficult to reach out to people with information. Unless, of course, you spend a large fortune in advertising and then there are still people who are unreachable.

When something changes in the diabetes health service how do we let people know?

In the last few years there have been at least three major changes that affect people with diabetes in Ireland. This is just off the top of my head.

  1. In 2014, the HSE rule which prevented people with diabetes from holding both a medical card and a Long Term Illness book was changed to allow it. This meant that thousands of people with diabetes had to be informed that they now needed to apply for the LTI and should not be paying a prescription charge for the diabetes supplies and medications. I’m still coming across people in the diabetes online community who haven’t been informed of this!!!
  2. In April 2016, Restrictions were placed on blood glucose meter test strips for people who do NOT use insulin. See here.
  3. Most recently, April 2017, the change in the sugar content of Lucozade in both UK and Ireland. Every diabetes organisation and group carried this news and it even made it into mainstream media in both countries. There were posters in diabetes clinics (however, we are all looking down at our phones) all over the country. And there are still people who have not received this information, even though they are actively engaging in social media for their diabetes information. There are also people living in this world who even if you put the information right under their noses they still won’t see it. And given my broccoli evidence above this could be me!?! Aaaahhh!

This makes me hugely worried for the all of those people with diabetes who do not engage online for diabetes information. We tend to forget that a very large portion of the diabetes community is not engaged online at all. We can’t rely on the diabetes medical teams to reach every single person who attends their clinics with new information – it’s just not feasible or even possible. Someone will always slip through.

I think this is why offline diabetes peer support can play a huge role. We can help make sure noone falls through!

Diabetes Blog Week – Day 4 What brings me down

This week is the 8th Annual Diabetes Blog Week and my second year participating. Diabetes Blog Week was started by and is still instigated by fellow type 1 Karen Graffeo in Connecticut who blogs at Bitter~Sweet Diabetes​.

This week is as a way for Diabetes bloggers (well over 100 participants from ALL OVER the World each year!) to share a huge variety of perspectives on issues relating to our illness. Learn more about Diabetes Blog Week here.
#DBlogWeek

Diabetes Blog Week – Day 4 – What Brings Me Down

Today let’s revisit a prompt from 2014 – May is Mental Health Month so now seems like a great time to explore the emotional side of living with, or caring for someone with, diabetes. What things can make dealing with diabetes an emotional issue for you and / or your loved one, and how do you cope? (Thanks again to Scott for this 2014 topic.)
I seem to be in a good place with my diabetes management at the moment, as I’m blogging less about my own diabetes experiences and more about what is going on in my wider diabetes bubble.

So my “What Brings me Down” blog post is more about all the things that are frustrating, overwhelming and make me want to cry in the world of diabetes advocacy.

However, there is one area that does bring me down recently. Several nights, not in a row, of CGM alarms disrupting my sleep are bring me down. Is it just a phase or is it a new trend? Being overwhelmed with the night time alarms not being consistent so I can’t use the information to make changes is bringing me down.

Oh and the thoughts of doing basal rate checks is bring me down too. I’ve no problem doing, no, I’ll correct that to, I have the least resistance in doing basal rate checks at night. Go figure that one!

My anxiety levels elevate a bit when I consider doing basal rate checks during the day because I’m always running around and I “chauffeur” during the day (school dropoffs and pickups). So, and please don’t be horrified by this, but in my 7 years on an insulin pump I have not done basal rate test in daylight. But since I learned more about Sugar Surfing last weekend I have a renewed ambition to tackle this.

What seriously brings me down is trying to explain what living with diabetes is like for me and not receiving compassion or understanding. Being met with the challenge of lack of knowledge and being met with a lack of empathy because the tabloid media and some health care professionals continue to reinforce the myth that diabetes is a self-indulgent condition and therefore deserved.

What brings me down is trying to fundraise for anything related to diabetes, especially to improve diabetes health care services in Ireland, in a world that doesn’t seem understand or want to understand why we need those things. What brings me down is how heavily we rely on our own community to fundraise when we are such a small one.

What brings me down is hearing that a new, much needed, health care professional has (finally) been appointing in a diabetes clinic only to find out that a vacancy or funding is pulled from another clinic in another part of the country. Case and point here;

“– In Waterford, the vacant Consultant post there was advertised last year and we have to wait over 6 months for interviews to be held and possibly up to a further year for the post to be filled.

– Following the transfer of a Consultant from Sligo Hospital to Limerick University Hospital, nothing is being done to date to recruit a replacement in Sligo.

– In Galway University Hospital, we are waiting for interviews to take place for the vacant Consultant post there which was recently re-advertised following the withdrawal of a successful candidate who was returning from abroad and who had accepted the post in 2015 and was due to start in 2017.” Source Diabetes Ireland

What brings me down is the fact that our health service published a standard of care document for children with type 1 diabetes in December 2015 and have absolutely no progress or indication that it will be implemented any time soon.

And finally, what brings me down is the fact that there is NO standard of care document for adults with type 1 diabetes and even if the health service ever gets around to publishing the delayed since June 2016 document for us, I feel like it will never, ever be implemented and I am on my own to advocate for myself.

It’s the never-ending-ness of the work needed in the diabetes advocacy world and the constant two steps forward, one step back and sometimes two steps back, that brings me down the most.

But I suppose it keeps me distracted from my own type 1 diabetes getting me down.
:-S

Irish Blog Awards Long list

Aaaageees ago you may remember that I ask for you to nominate this blog and the Thriveabetes blog for an Irish Blog Award. Well, guess what!!!!

We all made the long list!!! Both Thriveabetes and Blood Sugar Trampoline are in the Best Health & Wellbeing Blog category. And Blood Sugar Trampoline is also in the Best Blog Post category. I’m afraid I could not pick from all the amazing blog posts from all of you to nominate one for Thriveabetes.

So what’s next in this award process.

Well, now I have to wait and see if we make it onto the short list and the judging criteria for this is;

  • Is the blog regularly updated (at least once a month on average)? Yes
  • Does the design support or interfere with the reading experience? Yes & No, I think?
  • Is the blogger passionate about and knowledgeable about the subject? YES! YES!!!! and YES!
  • How easy is the blog to navigate? Uuumm yees?
  • Is the blog responsive to PC, mobile and tablet browsing? Yes

If we make the short list the next stage will be some of the dreaded Public Voting. And I suck at it!!!

“The shortlisted blogs will be opened up to a Public Vote so the more you promote your entry the better.
The Public Vote is worth 20% of the overall mark (the other 80% is decided by our judging panel). To help you out we will send you “vote now” buttons which you can use on your blog and social media.” from the Littlewoods Ireland Blog Awards webpage.

While awards don’t make the blog it would be nice to create more awareness of diabetes and the support available for people living with diabetes. You can never have enough awareness, and that is for sure.

Download (PDF, 692KB)

Treasures from the Diabetes Online Community

Every now and again the DOC sends you something wonderful in real life, or in this case someone wonderful, who you would never have met otherwise. And I feel lucky that I’ve had a couple of those opportunities already this year.

On Saturday last, I met one such person; Gina Gaudefroy. I don’t know how Gina found me last year but she did and sent me an email. We exchanged some of our stories in a couple more emails. Gina shared that she is originally from Limerick but now lives in California. She is very involved in her diabetes community and in participating in many clinical trials. Her diabetes clinic is one of the few participating in the Bigfoot Biomedical Open APS trial and the ViaCyte transplant trials.

Last week, she messaged me saying she was going to be in Ireland, staying in Co. Offaly and could we meet? Hold up! My first question was what the hell are you doing in Offaly, very close to where I grew up? My Irish nosiness kicked in. It turns out that Gina’s father comes from there.

I waited until she arrived to quiz her more about her ancestors, in true Irish tradition. And gave her some of my family history to return with so that she could determine if anyone in any of our families knew each other. And yes! Not only do we have diabetes in common but her father’s people know my people!

Our paths may never have crossed or a connection made if it had not been for social media in particular the DOC. Our diabetes prompted us to connect personally but now we have lots more reasons to stay in touch. 😀

Gina & Me
Gina & Me

Diabetes Summit Review

I had so much to write about from the Future Health Summit on Friday 27th May last that I had to divide it into two post.

Disclaimer: The organisers of this conference reimbursed me for my travel expenses to attend as a patient speaker. But all opinions are my own.

Here is my review of the Diabetes Summit Event which was chaired by Dr. Ronan Canavan, co-chaired by Anna Clarke from Diabetes Ireland with our panel being chaired by Dr. Eva Orsmond. This was the event that I spoke at. I was last up on the agenda. I have to tell ye, I think I have the bug. Even though, I seriously thought I would need medical assistance because my heart was pounding so hard while I was waiting to go up, once I got up there – I had a ball!

The summit began with Dr. Ronan Canavan, outgoing Clinical lead of the National Clinical Programme for Diabetes and Consultant Endocrinologist, and an overview of what the Diabetes National Clinical Programme has accomplished under his leadership. This included the National Diabetes Podiatry Programme, the establishment of The Diabetic Retina Screening Service, the Type 2 Diabetes Cycle of Care, which we are seeing happening now, the publication of the Paediatric Model of Care for all Children with diabetes and the forthcoming Model of Care document for Adults with diabetes.

Professor Gerald Tomkin gave a wonderful presentation about something very medical but did not fail to be extremely amusing. Actually I giggled a lot! I should add that this conference was primarily attended by healthcare professionals and patients were in the minority.

Dr Neil Black, talked about the reforms that his team have made in Diabetes West, which is not Ireland West but Northern Ireland west.  They have made some very seemingly small but significant changes. They’re approach is to identify the problems in the diabetes service from the patient’s perspective. Some changes were easy, such as changing the name of the diabetes clinic to diabetes support service – it sounds so much more caring. They have also streamlined the pathway to receiving care so that the people who need more support have more access and the people who are in a good place can step back until they need a check in.

2016-05-27 14.53.45

Prof Philip Home-Professor of Diabetes Medicine, Newcastle University. Former Chairman of the International Diabetes Federation (Europe). In 2009 he was Programme Chair for the IDF World Diabetes Congress in Montreal spoke about medications for lowering blood glucose. Again, another well seasoned presenter and charming gentleman but well above my head. 

Dr Richard Lee Kin-Specialist Periodontist and founder of the Mint Clinic in Adelaide Rd., Dublin 2, pointed out why dental hygiene is so important for people with diabetes. He also inform us that people with diabetes can get two dental exams for free every year. I’m hoping to have more information on this about where you can download the form to apply in advance, if you are a PAYE contributor. It’s more straightforward if you have a medical card, see more information from Citizen’s Information.

Then there was me and my scenic journey to becoming an empowered patient, or as I would rather put it “my own best advocate”.

Once everyone has presented, we concluded the summit with a panel discussion where Dr. Eva Orsmond and members of the audience had to opportunity to question us. Things got a little tense for a moment or two during this questioning, but thanks to Anna Clarke the tension was alleviated.

All in all it was not your average day in the office. It was lively, informative and I’m very glad I had the opportunity to participate and attend.

Future Health Summit Review

I have so much to share from the Future Health Summit last Friday I really don’t know where to start. So. Much. To. Write. It was very much an honour to have the opportunity to attend and to get a glimpse into the health care professionals’ world and to have access to a diverse range of AM-azing speakers from all areas of health.

Friday morning, I arrived in, what I thought, was plenty of time to browse the exhibits but due to a minor mix up in the timetable I lost forty five minutes of that time. I met some really interesting people though, who do some very important work and some very interesting delegates.

The first part of my day was spent attending the Diabetes Ireland workshop, which was consolidated with the ARCH workshop.

I have to say that I feel a new & engaging phase of diabetes patient conferences evolving. The diabetes conferences that I had been going to in Ireland were stale for me. They were very much medically driven and about getting to know the basics. They were not at all engaging, or very seldom and I wasn’t learning anything new at them so I stopped going.

Future Health Summit Logo

In 2014, I had my first experience of what a patient conference could be when I went to my first diabetes conference where the speakers really, I mean really, engaged with their audience. It was almost like we were at a Baptist church service and I just wanted to stand up and sing “Halleluia”! I called these guys and gals Diabetes Rock Stars. And these guys blog, have websites, run organisations and are well known in the diabetes world. You know who I’m talking about because we are bringing a small number of them to Thriveabetes.

But in recent months, as I do more and more blogging and advocating and learning and meeting new diabetes people I’m beginning to realise that we are growing our own crop of Diabetes Rock Stars right here in Ireland. I can see it happening and it’s so exciting. The two I will mention today are Diabetes Ireland’s very own, Anna Clarke and Kate Gajewska (no she’s not Irish born but we are keeping her:-)

Kate’s “Top 10 Tips for living with Diabetes

Kate presented her “Top 10 Tips for living with Diabetes”. But they weren’t what you might have assumed they were. She told us not to forget to live and play, that diabetes is part of our lives – don’t let it become our whole lives. Become an expert in diabetes – find out what it is, how insulin works, how carbohydrate is absorbed – there is nothing as empowering as knowledge. They are just a couple of the gems she shared. And she told us her diabetes story of growing up in Poland and how her parents bought her first blood glucose meter when they first came out and then they bought her first pump. How expensive they were but that her parents know how much a difference they would make in her life. I hope to have more information about Kate in the coming months on the Thriveabetes blog.

Anna’s ” What to expect from you annual diabetes clinic appointment”

Anna Clarke gave us her version of what to expect from you annual diabetes clinic appointment. It was clear that Anna knew most of the people with diabetes in the room had type 1 and I think she also knew some of us personally. She delivered a talk that was specific to us. Us, who have been around the diabetes block for a while and do our homework for our appointments. So, she told us that we should not be afraid to speak up at our appointments, especially if we don’t feel listened to. That, even if our doctors and nurses don’t see us as equals, we should still see them as ours. And to focus on getting more time with our Diabetes Nurse Specialists rather than our Endocrinologists.

Shane O’Donnell & The ARCH Workshop

Next up was the ARCH workshop which was extremely interesting and gave me a little introductions to sociology presented by Dr. Shane O’Donnell was presenting it with his colleague, Dr Maria Quinlan.

ARCH is the Applied Research for Connected Health, and “is at the centre of an unparalleled connected health education and research infrastructure that spans a range of activities from gathering, analysing and interpreting data, through the development of new knowledge and care models to implementing and evaluating change.”

Shane, you might remember from a previous post, is Ireland’s representative on the International Diabetes Federation’s Young Leader in Diabetes Programme. And even though he had written a piece for Thriveabetes, which you can have a read of here – we had yet to meet. Cool Bananas! Box ticked!

 

I know that I’ve come across a couple more Irish people in diabetes who qualify as “Rock Stars” – but I thought I would just give you a little flava.

We had a quick break for lunch. And then my afternoon was spent attending the Diabetes Summit, where I was presenting. I have to tell ye, I think I have the bug. TBC This post is long enough:-)

Apologies for the lack of photo, I really need to upgrade my phone:-(

Diabetes Blog Week

Super excitedI’m sooooooooooooooooooo excited about taking part in my very first Diabetes Blog Week, the 7th annual Diabetes Blog Week, which runs from 16th to 20th May. I’ve admired Karen at Bitter Sweet Diabetes for a number of years so I’ll say it again. I’m soooooo excited! 

We are all kicking off Diabetes Blog Week by talking about why we do what we do.

I write a blog because is a form of therapy for me – even since my early teens I used writing as a way to feel better about the world and about life. The making it public came about because I have too much to say and I like to listen. I’m part of a real-life diabetes support group and I need to zip it at those meetings. I do still talk and share at them but it’s my one opportunity to hear about other people’s’ experiences and diabetes stories, and so I zip it as best I can.

So, Blood Sugar Trampoline is where I let it rip – nicely;-).

The most important diabetes awareness message I want to share is that the diabetes community needs to raise their voices if they want to improve our health service. At the moment, our health service is under resourced and inefficient. But the voice of the patient is a powerful one and a lot of us don’t realise that.

I’m passionate about fighting for the health service we, men, women and children with diabetes, deserve. It’s a big task and it’s a slow one. We have a lot of work to do in Ireland to improve our health service for people with diabetes and we only have only organisation trying to do it all. They are doing the best they can with their limited resources they have but they need us to help them. My husband told me back in 2007, that one of the ways you can make an organization better is to be part of it.

I hope that in some small way Blood Sugar Trampoline will inspire more people with diabetes to advocate for themselves and others. Many hands make light work!

Diabetes Summit & Future Health Summit Dublin

I am extremely honoured to have been selected as a patient speaker at the upcoming Diabetes Summit which is part of the Future Health Summit on Friday 27th May. The Future Health Summit runs over two days, May 26th and 27th, in Dublin’s Citywest Convention Centre.

The Future Health Summit is actually a series of 15 separate summits covering areas such as mental health, medtech, oncology, wellbeing at work, clinical leadership, diabetes, ehealth, and homecare.

The Summit director David Neville expects 1,500 delegates to attend. There are seven patient forums, more than 100 speakers, over 120 exhibitors, and 15 separate summits being run. He also says “The conference is focused on how we care, what we eat and how we live”.

I will be participating in the Diabetes Summit, which is chaired by the Clinical lead of the National Clinical Programme for Diabetes and Consultant Endocrinologist, Dr. Ronan Canavan and co-chaired by Dr. Anna Clarke, Health Promotion and Research Manager with the Diabetes Ireland.

My fellow panel will include;

Future Health Summit Diabetes agendaDr Neil Black, Endocrinology & Diabetes Physician, and Lead Clinician, Electronic Care Record Implementation in Northern Ireland.

Prof Philip Home-Professor of Diabetes Medicine, Newcastle University. Former Chairman of the International Diabetes Federation (Europe). In 2009 he was Programme Chair for the IDF World Diabetes Congress in Montreal.

Professor Gerald Tomkin – Director of the Diabetes Institute of Ireland at Beacon & Endocrinologist, former president of the Irish Endocrine Society, the Irish Hyperlipidaemia assoc.s. Former Chairman, and now President of the Diabetes Federation of Ireland.

Dr Richard Lee Kin-Specialist Periodontist. He is founder of the Mint Clinic in Adelaide Rd., Dublin 2, dealing exclusively with the management and treatment of gum disease in adults and children .

And of course, me, Grainne Flynn-Patient Speaker.

With a panel discussion with all speakers chaired by Dr Eva Orsmond and Prof. Donal O’Shea.  No intro explanation needed for either of those. There is more information on the schedule.

 

Patient Workshops

There are also patient workshops taking place on Friday 27th May, one in particular of interest is the “Living with Diabetes- Personal Empowerment, Information, Choice and Ownership”. Speakers for this workshop include;

11.15 am  – “Living Well with Diabetes, A Personal Experience  – 10 Keys Tips”. Kate Gajewska who is a health psychologist, lives with type 1 diabetes and is a scholar in Population Health & Health Service Research – SPHeRE Programme

12.00     “Making Best Use of Your Professional Diabetes Review”  Prof. Seamus Sreenan, Consultant Endocrinologist at Connolly Hospital and Medical Director of Diabetes Ireland.

Professor Seamus Sreenan will advise individuals to better prepare for their hospital appointments and maximise the benefit of that appointment for the person with diabetes.  Professor  Sreenan is Clinical Director, 3U Partnership, Consultant Endocrinologist at Connolly Hospital and Medical Director of Diabetes Ireland.

Both presentations will be followed by a question and answer session.

 

When you book this event, your ticket gives you access to the open talks at the Summit  (tickets priced at €539). Admission to the workshop is €10 registration fee for members, or €40 to include 2016 membership of Diabetes Ireland. To register call  Diabetes Ireland on  1850 909 909.

Now I have to take care of a “Procrastination Monkey” by rounding up the “Panic Monster”. This very entertaining video will explain more:-)

The Great Sugar Confusion

Are you as tired as I am of hearing about sugar and all its evils?

**** I am not a health care professional nor do I have anything that looks remotely like a medical degree. So take anything I say with a pinch of salt.

The Great Sugar Confusion was originally posted on the 9th October 2013. I have taken a different spin on it this time.

Everyday, it seems like there’s another “sugar scare” story!

And yes, I know that too much sugar is not good for us, any of us but I get so confused when I try to understand what these articles are trying to tell us and how to explain it to someone else.

I know that these pieces are written by well intentioned people, even qualified medical professionals,  who are trying to educate the masses but everytime I see one of these articles I get “irked” because I feel that the healthier foods are being branded as “bad” too.

People with diabetes, despite the truth, are taught that sugar = poison. I feel this is changing in the diabetes community but the rest of the world will continue to be stuck in this time warp for a long time to come.

So, if someone shows you an image like this ;  Sugar httpwww.bbc.co.ukscience021843942

and you have diabetes and are not very carb-aware, you might assume that you can’t eat any of these three items.

For me, I get confused because I don’t know if it’s representative of the sugar that is added when the food is being created or if that’s what the carbohydrate becomes when digested into glucose. I don’t know if my reaction should be “Gosh, I didn’t know that!” Or “Yes, I knew that”. What, just what are you trying to tell me????

Educating the masses about the complexities of our food and how it affects us is a huge challenge. So many different approaches have been tried but haven’t really succeeded.

However, I do think that people with diabetes, especially those of us who count carbs to match insulin, have a leg up on this one. Learning to read a food label has been the best tool for me to know exactly what I’m eating, it’s even better if there are very few ingredients in it or if my food is cooked from scratch. The closer the food is to the farm the better it is. But it’s also a tool I HAVE to rely on to stay healthy and not let diabetes take me down.

It’s probably not very realistic to expect all others to scrutinise their food labels as I do. But it might be realistic to teach this in our primary or secondary schools along with how our digestive systems work? I mean that stuff has stayed with me.

This is what I remember from my 2nd year biology class.

  • – starch + sugar = Carb
  • – bite, chew-chew-swallow, swish-swoosh in the stomach
  • – presto = glucose.
  • –  Glucose floats around in the blood, gets absorbed by cells = energy.
  • –  Leftover glucose get stored for a while then gets turned into fat.
  • –  Done! A+ for me…. surely?

Molecular Structure Table Sugar

For those of you who would like a bit more science, have a look at this really good website; basic biology of digesting carbohydrates.

The Clare branch of Diabetes Ireland is hosting a Diabetes Education event will feature a dietitian who will talk about “being sugar smart”, on Tuesday, May 17th in The Temple Gate Hotel at 8pm. It’s going to make for a very interesting evening and hopefully be enlightening.

The Luck of the Irish

As we celebrated St. Patrick’s Day last week, I began to reflect of what it’s like to be a person with diabetes living in Ireland.

St Patricks Day

The luck o’ the Irish is often referred to in movies, etc, but in actual fact, when it come to diabetes, I think we should called it lucky to be born in Ireland.

We have socialised medicine here, we called it public healthcare. It gives us free test strips, blood glucose meters, insulin and lots of other diabetes medicine without any stipulations.

Private healthcare is an option here too but it usually only covers hospital treatments, although the insurers are starting to cover primary care visits a little.  With private health insurance you could get a private scheduled appointment with an endocrinologist but you don’t, in most cases, get the backup of a diabetes nurse specialist or a dietitian.

When I hear stories from my friends in America, especially when I read Riva Greenberg’s piece in the Huffington Post about battling with health insurance companies for diabetes supplies I’m truly thankful that the reason Diabetes Ireland was formed in 1967 was to ensure that diabetes was included on the Health Service’s list of long term illnesses and therefore providing us with free medication and supplies.

We also have excellent health care professionals working in our clinics, just not enough of them.

Sure, there are lots of other things that we don’t have but we are advocating strongly for, such as national access to structured diabetes education, access to psychology, unlimited access to insulin pumps and continuous glucose monitoring.

And dealing with the health care professionals outside of the diabetes setting is frustrating. And yes, I did have to haggle with my diabetes team to make sure I got my insulin pump 6 years ago and my CGM last November. And yes, sometimes I don’t feel listened to at my clinic. But these are problems that are global.

But we don’t have to beg, wrestle or finance our basic diabetes needs.

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